PROJECT SUMMARY/ABSTRACT Over 15% of children in the US are raised in Spanish-speaking homes. However, clinical assessment of speech perception in preschoolers and school-age children is generally performed using English materials presented in quiet, in steady noise, or in multi-talker babble. We know that speech perception scores are better when testing is performed in a listener?s native language. We also know that hearing impairment has a more detrimental effect on speech perception in a complex masker (e.g., 2-3 streams of speech) than in noise or babble. Therefore, the typical approach of evaluating Spanish-speaking children?s speech perception, using English targets and steady noise, is unlikely to provide a full account of functional hearing. The goal of this proposal is to develop a clinical test for evaluating masked speech perception in English and in Spanish, in either a complex speech or a steady noise background. The proposed work builds on the feasibility study of Calandruccio et al. (2014b), which introduced a four-alternative, forced-choice picture-pointing threshold estimation task that can be administered in either English or Spanish. Target words are disyllabic nouns familiar to young children, and maskers are either speech-shaped noise or two-talker speech. The recorded instructions and picture-pointing response means the tester need not be fluent in the test language. The four- alternative format also accommodates assessment of children with poor speech production. Aim 1 will refine the test materials and procedures, including optimization of threshold estimation parameters and implementation of software for a clinical setting. Aim 2 will establish test reliability and validity across listener age and hearing status. Threshold norms and estimates of psychometric function slopes will be obtained for 4- to 12-year-olds, including both Spanish/English bilingual and monolingual English speakers. Performance of children with hearing loss, including hearing aid and cochlear implant users, will be evaluated relative to estimates of functional performance in real-life listening situations. Aim 3 will evaluate the test procedures in seven busy pediatric audiology clinics. Test results will be compared with measures that are currently used to evaluate Spanish- and English-speaking children (e.g., pure-tone thresholds and English-language PBK scores), and with questionnaire data from parents regarding language proficiency and functional hearing ability. Clinician feedback will be solicited to further improve test procedures. The research team assembled to carry out the proposed work includes expertise in basic hearing science, auditory development, clinical research, bilingualism, and the provision of clinical care, ensuring that the final product will be a clinical instrument that is both rigorous and practical. The end result is expected to improve our ability to audiologically evaluate and manage children who speak English, Spanish or both languages.